Use of bacterial vaccines for prevention of pneumococcal and meningococcal disease in the day care setting.

The pneumococcus causes severe disease, including meningitis and bacteremia, in children of day care age. It is also a frequent cause of otitis media. Unfortunately, the currently available pneumococcal polysaccharide vaccine has not been efficacious in children under 24 months old; research is currently underway on methods for increasing immunogenicity in young children. The meningococcus is a rare cause of meningitis in day care aged children, but children in day care are likely to be at increased risk of secondary disease if a case occurs in a center. The currently available polysaccharide meningococcal vaccine is poorly immunogenic in children younger than two and does not include the group B polysaccharide, which is responsible for 70% of disease in children younger than five years. Therefore, chemoprophylaxis with rifampin is recommended for decreasing the risk of secondary spread. When a group B meningococcal vaccine immunogenic in young children becomes available, vaccination will be indicated for all children in day care.